title: Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients.
abstract: OBJECTIVE
  Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy.
  
  
  METHODS
  Prospective data were collected on 806 consecutive trauma patients admitted to the intensive care unit over 2 years. Patients were stratified by PRBC:FFP transfusion ratio over the first 24 hours. Stepwise regression models were performed controlling for age, gender, mechanism of injury, injury severity, and acute physiology and chronic health evaluation (APACHE) 2 score to determine if early aggressive use of PRBC:FFP improved outcome.
  
  
  RESULTS
  Seventy-seven percent of patients were male (N = 617) and 85% sustained blunt injury (n = 680). Mean age, injury severity score (ISS), and APACHE score were 43 +/- 20 years, 29 +/- 13, and 13 +/- 7, respectively. Mean number of PRBCs and FFP transfused were 7.7 +/- 12 U, 6 U, and 5 +/- 12 U, respectively. Three hundred sixty-five (45%) patients were transfused in the first 24 hours. Sixty-eight percent (n = 250) of them received both PRBCs and FFP. Analyzing these patients by stepwise regression controlling for all significant variables, the PRBC:FFP ratio did not predict intensive care unit days, hospital days, or mortality even in patients who received massive transfusion (> or = 10 U). Furthermore, there was no significant difference in outcome when comparing patients who had a 1:1 PRBC:FFP ratio with those who did not receive any FFP.
  
  
  CONCLUSIONS
  Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.
authors.affiliation: R Adams Cowley Shock Trauma Center, Division of Clinical and Outcomes Research, Department of Surgery, Anesthesiology, and Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. tscalea@umm.edu
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Bochicchio
authors.forename: Kim
authors.initials: K
authors.lastname: Lumpkins
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
authors.forename: Richard
authors.initials: R
authors.lastname: Dutton
authors.forename: Anne
authors.initials: A
authors.lastname: Pyle
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010949:Plasma; D011446:Prospective Studies; D013997:Time Factors; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*